This article originally appeared in the November/December 2020 issue of the Ontario Medical Review magazine.
by Sharon Bal, MD, CCFP, FCFP
Clover Hemans BScN, MD, CCFP, FCFP, MScQIPS
Co-Chairs, OMA Women
In August 2020, the Ontario Medical Association (OMA) released a report titled Understanding Gender Pay Gaps Among Ontario Physicians, examining the issue of pay equity in medicine. The OMA is the first medical association in Canada to undertake this kind of work and the study, based on the OHIP billings of our 31,000 practising colleagues, is the largest of its kind.
This report was generated by the OMA Physician Human Resources Committee (OHRC), based on data analysis by the OMA Economics, Policy & Research Department, after Council approved a motion by OMA Women co-chair Dr. Clover Hemans in 2019. To the surprise of few, the gender pay gap was confirmed to be real, and was identified by the OMA to be a 15.6 per cent wage gap between male and female physicians, with variations between specialties.
OMA Women would like to thank the Ontario Medical Association for beginning this important work. In particular, we would like to acknowledge OMA President Dr. Samantha Hill, who has made gender equity and overall diversity one of the top priorities of her year in office.
It is important to note that OMA Women reviewed the report before it was released and provided significant constructive feedback. Our committee highlighted several considerations for this report and for future research, including wider review of existing literature on the topic and notes on methodology. Moreover, we believe that new research should be undertaken to examine the effects of the feminization of certain aspects of medicine, the value of work performed by women, the importance of qualitative data analyses, and so on.
We also advocated for further analyses on the nuances of complexity of care modifiers as much of the unpaid “extra” service provided by women is not adequately captured in the current complexity model. Although this feedback was not included in the issued report due to tight timelines, we note the report to be an important first step and much work remains to be done.
Now that Ontario physicians have evidence of a significant gender pay gap (GPG) favouring male physicians, we need to determine the causes. We need system-level remedies to what we believe are system-wide causes of the gender pay gap, such as whether female medical students are steered toward lower-paying specialties and whether there is conscious or unconscious gender bias in referring patients to specialists. We must ensure that changes to the OHIP Schedule of Benefits is undertaken with a gender lens.
On November 27, OMA Women partnered with the OMA Section of General and Family Practice (SGFP), as well as OMATalks, to co-sponsor an important event bringing topic experts, member experiences and musical entertainment together in an event called Healing the Gender Gap. This delightful evening was attended, virtually, by more than 300 of our members and moderated by CBC journalist Anna Maria Tremonti.
Sprinkled throughout the night, nine personal vignettes from women and men physicians across the province, in varying career stages, were shared with the audience. These deeply personal narratives included OMA Women co-chairs: Dr. Clover Hemans discussed systemic discrimination as part of our collective socialization, and Dr. Sharon Bal reflected on motherhood and unconscious bias as barriers to leadership roles for women physicians. Several OMA Women Committee members shared their own stories:
Sharing their lived experiences of discrimination with fellow OMA members was an important step in understanding and healing the gender gap.
Drs. Tara Kiran and Michelle Cohen, family physicians, researchers and associate and assistant professors at the University of Toronto and Queen’s University, respectively, brought vigorous research, enlightened analyses, and feisty discussion to the topic of the GPG. Their outstanding October 2020 CMAJ article, Closing the Gender Pay Gap in Canadian Medicine, provided clear evidence that the GPG exists within every medical specialty and between specialties with physicians in male-dominated specialties receiving higher payments. They also plainly noted that the GPG is not explained by women working fewer hours or less efficiently, but instead assert that this inequity relates to systemic biases in medical school, hiring, promotion, clinical care arrangements, the fee schedule and societal structures. Dr. Cohen cited a JAMA 2012 study that found a $44,000 pay gap in academic surgery and estimated that there is a lifetime net loss in wages for women of upwards of $2.5M.
Dr. Sharon Straus, physician-in-chief, St. Michael’s Hospital presented evidence-based data on the gender inequities in academic medicine. From the desk at her office of leadership, Dr. Strauss openly and distinctly laid out the data indicating that compared with men, women academics are:
Dr. Straus affirmed that the way to change these discriminatory practices was to change the culture. We know this is extremely difficult, but we can start by looking at making more equitable access to resources and opportunities, such as: facilitating mentorship, equitable compensation, adequate resources for career development, and informal networking events.
Lastly, minimizing unconscious race/gender bias is essential. Some thoughts on how to decrease this type of bias included formalizing the recruitment and selection process and by mandating training in unconscious bias. By itself, this training is not a solution but does raise awareness. Resonating with the audience was the concept that allies should perhaps “lean back” to create space and opportunity for women, instead of continually expecting that they “lean forward.”
Dr. Gianni Lorello, assistant professor, inaugural chief diversity officer of the Department of Anesthesia and Pain Medicine at the University of Toronto and solid #HeForShe ally, spoke virtually on the gender inequities in academic medicine, residency matching and inherent, unconscious (implicit) personal and systemic biases that occur when reviewing resident applications. These biases underpin evidence-based data showing that male applicants are still being matched to male-dominated specialties and female applicants to female-dominated programs such as family medicine, psychiatry and emergency medicine. Although further research is indicated, the results above may reflect stereotyping, the hidden curriculum, and exposure to the specialty and/or mentoring opportunities. Dr. Lorello also noted that increasing representation of all sexes and genders at a faculty level may increase medical student interest as learners can see role models and thus, see themselves in that role.
We appreciated Dr. Lorello’s commitment and passion in the area of ally-ship as he worked to interact in our panel discussion while on-call, demonstrating “real world” authenticity and a passion for diversity, equity and inclusion.
The Healing the Gender Gap event gave us an opportunity to unpackage and discover a range of experiences from exploring some of the more complex, and at times, contentious issues that surround gender roles, gender-related inequities in remuneration, as well as learning from leaders and allies on how we can reflect and support our colleagues for a more equitable and ultimately, more just profession.
Finally, in honour of our late colleague, the brilliant Dr. Elana Fric, an appeal was made for donations to the Shoebox Project, supported by the Ontario Medical Foundation and the Ontario Medical Association. In light of the pandemic, this year $50 gift cards will be given to women in shelters, on the streets or in underhoused situations, for the purchase of items needed most in the pandemic. The OMA committed to matching raised funds up to $10,000. To date, more than $21,500 has been raised.
Healing the Gender Gap – with its open dialogue and panel discussion should move the dial in the direction of increased knowledge translation, understanding and hopefully change for improvement. Healing the Gender Gap is a worthy goal.
OMA Women are committed to collaborating even more closely with OHRC as this work continues, to being part of this analysis, to finding solutions and to ensuring changes that promote equity in our profession. A goal, we believe, we all share.
Please continue this conversation, this movement, and ensuring an outcome of gender equity, by joining our OMA community page, Facebook (OMA Women), and follow us on Twitter (@WomenOMA).